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Payers are increasingly using episodes of care to measure and reward efficiency in health care. Much attention has been paid to the effects of different rules for assigning episodes to providers, but little to how individual costs are assigned to episodes. In this paper, we studied the extent to which the two most widely-used commercially available episode(More)
BACKGROUND The trigger tool methodology uses clinical algorithms applied electronically to 'flag' medical records where adverse events (AEs) have most likely occurred. The authors sought to create surgical triggers to detect AEs in the ambulatory care setting. METHODS Four consecutive steps were used to develop ambulatory surgery triggers. First, the(More)
BACKGROUND Providers use risk-adjustment systems to help manage healthcare costs. Typically, ordinary least squares (OLS) models on either untransformed or log-transformed cost are used. We examine the predictive ability of several statistical models, demonstrate how model choice depends on the goal for the predictive model, and examine whether building(More)
Patient Safety Indicators (PSIs), developed by the Agency for Healthcare Research and Quality (AHRQ), are administrative data-based indicators that identify potential in-hospital patient safety events. This study developed and tested methods for (1) applying PSIs to Department of Veterans Affairs (VA) discharge data, and (2) comparing VA with non-VA PSI(More)
OBJECTIVE The objective of this study was to evaluate the association between mental health functioning and lower extremity amputations (LEAs) in veterans with diabetes. METHOD A retrospective study of 1999 Large Veteran Health Survey (LVHS) respondents with diabetes who were Veterans Health Administration clinic users in fiscal years (FYs) 1998-2000 was(More)
OBJECTIVE Although decline in functional status has been recommended as a quality indicator in long-term care, studies examining its use provide no consensus on which definition of functional status outcome is the most appropriate to use for quality assessment. We examined whether different definitions of decline in functional status affect judgments of(More)
BACKGROUND Personal health records (PHRs) have the potential to improve patient self-management for chronic conditions such as diabetes. However, evidence is mixed as to whether there is an association between PHR use and improved health outcomes. OBJECTIVE The aim of this study was to evaluate the association between sustained use of specific patient(More)
PURPOSE To determine whether the 2003 Accreditation Council for Graduate Medical Education (ACGME) duty hours reform affected medical knowledge as reflected by written board scores for internal medicine (IM) residents. METHOD The authors conducted a retrospective cohort analysis of postgraduate year 1 (PGY-1) Internal Medicine residents who started(More)
Objective: The Patient Safety Indicators (PSIs) developed by the Agency for Healthcare Research and Quality identify potential patient safety events through administrative records. We sought to determine whether there were racial disparities in patient safety event rates in Veterans Health Administration (VHA) hospitals. Methods: We explored 5 years of VHA(More)
OBJECTIVE Health outcome assessments have become an expectation of regulatory and accreditation agencies. We examined whether a clinically credible risk adjustment methodology for the outcome of change in health status can be developed for performance assessment of integrated service networks. STUDY DESIGN Longitudinal study. SETTING Outpatient. STUDY(More)